Apart from the many changes associated with aging that take place in the body during and after menopause, vaginal dryness, irritation, itching, burning, and painful sexual intercourse can be the cause of much discomfort to a woman.
Menopause is the time when hormonal changes are occurring in the body – the main effect being caused by decreasing estrogen levels. This leads to a host of physical and mental signs, symptoms and complications.
Causes of Menopause and Post Menopausal Irritation
Postmenopausal Atrophic Vaginitis
The female hormone estrogen is responsible for keeping the vagina healthy and well-lubricated. By keeping the vaginal environment acidic, it helps to prevent the growth of harmful bacteria, thus keeping infections at bay.
Decreasing estrogen levels in postmenopausal women can lead to a condition known as postmenopausal atrophic vaginitis. This is the main cause of itching and irritation of the vagina in women during and after menopause. The changes that may occur in atrophic vaginitis are :
- The vaginal wall, including the vaginal lining (epithelium) becomes thin and delicate and may be easily injured.
- There is a decrease is the amount of vaginal secretion, causing dryness of the vagina. This may give rise to painful intercourse.
- During and after menopause, the normal acidic environment of the vagina which helps to guard against infections is often reduced. As a result, a postmenopausal woman may be more susceptible to vaginal infections, causing vaginal inflammation, irritation and discomfort. Read more on vaginitis.
Atrophic vaginitis may be seen in a woman during or after menopause normally occurring with age, or it may happen due to premature menopause caused by removal of the ovaries, such as during a hysterectomy operation where the uterus and both the ovaries have been removed. Premature menopause and a fall in estrogen level, leading to atrophic vaginitis, may also be caused by radiation therapy to the pelvis, or as a result of chemotherapy. Anti-estrogen drugs, such as tamoxifen, used in the treatment of breast cancer, may also lead to atrophic vaginitis.
Other Causes of Vaginal Irritation
The other causes of vaginal irritation during or after menopause may be the same as seen in women of any age group. This includes :
- Poor Personal Hygiene
Vaginal irritation may occur in women who are not particular about personal hygiene. Another aspect of this is when a woman is bedridden and nursing care is inadequate. Constant irritation caused by urine or feces may cause vaginal irritation.
- Vaginal Infections
Most commonly seen are bacterial vaginosis, vaginal candidiasis and trichomoniasis.
- Skin Conditions
Lichen sclerosus is an extremely itchy skin condition which may occur in menopausal women. Apart from its systemic manifestation, it may cause itching and irritation of the vagina and vulva. Psoriasis and eczema may also cause vaginal itching and irritation.
Frequent douching may cause vaginal irritation.
- Allergy /Irritation
Irritation caused by or allergy to latex condoms or spermicide gels. Semen allergy is a possibility too. Allergies to chemicals present in soaps, bubble baths, sprays, colored toilet paper, or deodorant tampons also needs to be considered.
Vaginal and endometrial cancers are typically seen in older women. Read more on vaginal cancer and uterine cancer.
- Sexually transmitted diseases
- Genital herpes and vaginal warts may contribute to vaginal irritation.
Treatment of Vaginal Irritation During and After Menopause
The cause of vaginal irritation has to be determined and treatment initiated according to the cause.
- Non-hormonal treatment, such as the use of vaginal moisturizers and water-based vaginal lubricants, may be of some help initially when the symptoms are minimal.
- Hormone replacement therapy (HRT). Since lack of estrogen is most often the cause of vaginal irritation in menopausal women, estrogen replacement has to be considered. To obtain relief from symptoms, estrogen may be applied locally in the form of creams or gels, or inserted in the vagina as a ring or suppository. It may also be given orally or as a skin patch. The possible side effects of HRT should be taken into account before treatment. Side effects may be less with local application than with oral tablets.
- Antimicrobial drugs – antibiotics (in case of bacterial infection) or antifungal drugs (for yeast infection).
- Antihistamines in case of allergies being the cause of vaginal irritation.
- Corticosteroids – creams and lotions may help to reduce inflammation.